Ginkgo leaves at Rhinebeck train station
Today, I'm writing about something that seems pretty obvious and intuitive to me, but may not be so obvious to others. I was motivated to write on the topic of when withdrawals stop, after a phone call with a patient who was going through a rough withdrawal.
Read on for some insights on the duration of medication withdrawals!
When do withdrawals stop?
When your body keeps going through withdrawal long after it "should've" stopped
A young woman recently wrote the following to me:
"I have been off Prozac 20 mg around 10 weeks. In the past two weeks, I have been in an unbearable state of constant panic attacks 24/7 with heart palpitations, racing thoughts, uncontrollable crying, and not sleeping. I have had terrible heartburn and upset stomach and diarrhea. I am at a breaking point and need help. I have been taking Ativan 2 mg at night for two years, and my doctor switched me to Klonopin. It makes my body sedated but my heart and mind are still racing and I can't sleep."
In her history, she informed me that she had been taking Prozac for over 14 years and Xanax for two years before switching to Ativan.
When I spoke to her on the phone, she said that the clinician responsible for prescribing her medications told her, "There's no way you are still going through withdrawal!"
Before I could stop myself, a snort of derision popped out of my mouth. Psychiatrists are supposed to be stoic and nonreactive to what patients say. More importantly, physicians are never supposed to criticize other physicians, at least that was what my training psychiatrist tried to instill in me during residency, but I just couldn't help that little snort from coming out.
Okay, I get it. The clinician was referring to the pharmacokinetic half-life of Prozac and her other medications and assuming that, since the medications are out of the patient's system, her withdrawals should be over.
However, that's like telling someone with severe frostbite that their blue-black extremities that died from exposure shouldn't be falling off since the ambient temperature is no longer freezing.
No, that analogy is not quite equivalent.
Here's another analogy. It's like telling someone that since the dam stopped providing water downstream ten weeks ago, that doesn't mean there should be a shortage of water for the town now.
Doesn't even make any sense, does it? That's because the reasoning doesn't make sense. It's simply a defense against the discomfort of one's powerlessness when addressing the problems of withdrawal. If one can't do anything about it, deny that it exists.
When do withdrawals stop? It stops when the body has adapted to the medication withdrawal with a state of healthy homeostasis.
A patient experiencing "panic attacks 24/7" is not in a state of healthy homeostasis, nor does her body care a whit about the pharmacokinetic half-life of medications. When the medications came out of her body, her body was unable to function without its support. She is in withdrawal because she doesn't have the functions to compensate for what the medications were doing for her. Until she does, she will suffer withdrawal.
Besides, all her G. I. and anxiety symptoms point to serotonin and GABA deficiencies and dysfunctions, functions that Prozac and the benzodiazepines mediate. The patient is obviously in withdrawal.
The patient stated that she was going to AA for her alcoholism but not taking any medications. I recommended that she go back on her medications, start taking some supplements, and learn how to do some energy work before trying to taper her meds.
From my perspective, stopping one's medications without a foundation of health to stand on is like putting the cart before the horse. It's just not possible to go anywhere when you do that.
A final few words of common sense when it comes to medication withdrawal:
When a person stops their psychiatric medications, physiological consequences follow. Surprise, surprise. Those physiological consequences can worsen the patient's overall function and health, making the next withdrawal harder to handle. Do this seven more times and you may never be able to come off the medications even with a bushel-load of supplements and all the energy medicine in the world. The frostbitten finger has turned black and fallen off and all the president's men can't make it grow back again. So, please do withdrawal right the first time, if possible.
Please spread some common sense into the world for me. Share this article with those who may benefit from it!